That article was Part One in a series on urinary tract infections (UTI), urinary incontinence, and Alzheimer's caregiving.

One question that I don't think gets asked often enough when a person shows signs of urinary incontinence is --

is the person getting bladder infections?

I am referring here specifically to patients living with Alzheimer's disease or a related dementia.

Think about it.

How many times have you had your Alzheimer's patient tested for a UTI? Does your doctor routinely check your patient for bladder infections. By routinely, I mean every month.

When the problem with urinary incontinence gets bad -- worse then usual -- do you immediately think you need to have the person tested for a UTI?

If a person is incontinent and they sit or lie around wet (even at night in bed) the likelihood that they could suffer from urinary tract infections goes up, way up.

E.Coli bacteria are the source of urinary tract infections. Damp underwear, or briefs, soaked with pee can be a source of E. Coli.

In the case of my mother, it became obvious to me after years of trying to solve my mother's problem with incontinence that she had a series of undiagnosed bladder infections.

I base this on a simple observation -- at times her problem was much worse than at other times. Later on, I learned that whenever the incontinence worsened she had a UTI. This was a simple case of one plus one equals two.

As I described in the previous article, we only discovered that she had a very serious bladder infection by accident.

The UTI that alerted us to this problem was not diagnosed by her personal care physician and he was "top notch". It was discovered because her temperature was slightly elevated from her baseline temperature and I thought she was getting dehydrated. The hydration test showed the UTI.

This ultimate discovery lead to my current beliefs and also lead me in the direction we needed to go. These findings lead me to an understanding that allowed me to solve the problem of urinary incontinence.

You read this correctly.

I solved the problem of urinary incontinence.

We did not use drugs or medication, we use what I call Bunkhouse Logic.

It was not because of her Alzheimer's disease it was because she had "silent" bladder infections. My mother did not feel any pain, discomfort, or burning sensation when she peed. This is why it is called a silent the bladder infection.

Over the years as I first got a "grip" on the urinary tract infection and then another "grip" on the incontinence, it finally became clear to me that these two can go hand in hand.

The bladder infections made my mother's incontinence worse and more difficult to deal with. This in turn made me the Alzheimer's caregiver more frustrated.

You should understand that when a person has Alzheimer's disease it is likely that they won't remember peeing on their clothing, pajamas, sofa or on the floor.

If they don't remember, then they don't know that there is a problem.

Trying to get them to remember, or convince them that there is a problem is a useless endeavor in my opinion. This kind of communication is counter productive to effective Alzheimer's caregiving.

In fact, trying to convince a person with Alzheimer's that they suffer from incontinence is likely to cause the exact opposite effect that you are trying to obtain. It is likely that you will make the person feel frustrated and angry. This leads to bad, hard to understand behaviors that are likely to drive you nuts.

Yes, bladder infections and/or urinary incontinence can be the source of mean spirited or hard to deal with behaviors on the part of someone suffering from Alzheimer's.

This in turn is likely to make you the Alzheimer's caregiver angry and frustrated.

And yes, your are likely to lash out from time to time. This puts you in an endless cycle that leads to one unhappy day after another.

When an Alzheimer's caregiver becomes angry and frustrated it is likely that they pass these negative emotions on to the person with Alzheimer's disease.

Whether a caregivers is conscious of this or not, this leads to a very bad caregiver experience all the way around.

It leads to day after day of emotional and psychological misery for both the patient and the caregiver.

I hope you are understanding my point here.

What I am describing is a viscous cycle of bad communication and misunderstanding.

I would ask any Alzheimer's caregiver that is dealing with the very real problem of urinary incontinence to try and understand that you cannot blame the person with Alzheimer's for peeing. If they could do something about it they would do something about it.

I would suggest that the caregiver sit down in a comfortable chair, in a dark room, and think about what I am saying.

Try to put yourself in the place of the Alzheimer's patient.

Try to imagine what it would feel like to pee all over yourself -- over and over.

Don't assume that the Alzheimer's patient doesn't feel shame or anxiety. Just because they cannot express themselves does not mean that are not feeling confused.

As a communication paradigm, anxiety (the inability to understand) leads to confusion which leads to mean spirited behavior. It is just that simple.

In closing this article I would suggest that you have your loved one, woman or man, tested for a bladder infection frequently -- especially if they are wet or getting wet overnight. I suggest that you make this part of every visit to the doctors office.

In our case, I obtained the sterile containers that hold the urine, and a urine collector that fits on the toilet and makes it easy to collect the urine and pour it into the container.

I take the urine sample right before we leave for the doctor's office. I take the sample in as soon as we get there. We know the result when the doctor comes into the room to examine my mother.

By the way, I take my mother to the doctor every single month. Monthly visits. This is a necessary component of effective care in my opinion.

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